LETTER TO THE EDITOR Spontaneous resolution of posterior ciliary artery occlusion Min Kim & Hee Jung Kwon & Sung Chul Lee Received: 14 November 2011 / Revised: 8 February 2012 / Accepted: 18 February 2012 / Published online: 6 March 2012 # Springer-Verlag 2012 Dear Editor, In posterior ciliary artery (PCA) occlusion, clinical observa- tion of restoration of choroidal blood flow with good visual recovery is quite rare, and in humans it has never been photographically documented. Herein, we describe a patient who presented with sudden loss of vision, which resolved spontaneously with marked visual improvement. A 58-year-old male was referred to our clinic for evalu- ation of a choroidal lesion. Ten days before presenting to our clinic, the patient had a sudden onset of precipitous drop of visual acuity in his left eye. A review of medical record from the previous hospital indicated a visual acuity of hand motion only at that time. Previous funduscopic imaging revealed irregular, patchy, elongated yellowish color changes in the retinal pigment epithelium (RPE) temporal to fovea (Fig. 1a). Visual field examination showed a defect in the corresponding area of the choroidal lesion. Early- phase fluorescein angiography (FA) disclosed a large area of hypofluorescence at the macula, extending to the inferior region with adjacent stippled hyperfluorescence, and a slightly delayed arteriovenous transit time of 15 seconds (Fig. 1b). A broad hypofluorescent filling defect at the posterior pole was noted, and the choroidal vein draining from the ischemic region displayed a relatively high level of fluorescence on the early-phase indocyanine green angiog- raphy (ICGA) (Fig. 1c). Ten days later, the patient’ s visual acuity progressively improved to 20/40. Anterior segment examination with slit-lamp biomicroscopy was unremark- able. Funduscopic examination could not detect the pigmen- tary changes observed earlier. FA still showed a slightly delayed arteriovenous transit time, but improvement of cho- roidal circulation was evident as depicted by the ICGA findings, and the striking appearance of increased blood flow in the choroidal vein connecting to the vortex vein was still present (Fig. 2b and c). An OCT image shows some remaining fluid in the macula (Fig. 2d). The patient did not consent to further investigations including blood tests, echocar- diography, and carotid Doppler scan. A sudden loss of visual acuity, pigmentary changes of RPE due to an RPE ischemia, and a wedge-shaped choroidal filling defect on ICGA all suggested an occlusion of long PCA or one of its branches as the final diagnosis. Elongated yellowish patches separated by narrow strips of presumably normal choroidal vessels were evident on the initial fundus photograph (Fig. 1a), resembling the finding of experimen- tal PCA occlusion in rhesus monkeys [1]. The temporal area of the fundus seemed to correspond with the diagrammatic representation of fundus lesions in experimentally induced PCA occlusion [1]. A histopathologic study by Loeffler et al. previously demonstrated necrosis of RPE and breakdown of blood–retinal barrier (BRB) in eyes with PCA occlusion [2]. Similarly, we speculated that the yellowish patches represented a portion of the ischemic edema of RPE as a result of acute choriocapillary occlusion, and a large area of hypofluorescence on the early-phase FA image can be as- cribed to an accumulation of fluid and lack of sufficient choroidal filling. Multiple stippled hyperfluorescence evi- dent on late FA images could be attributed to the staining of the distressed RPE. As ischemia has induced a release of VEGF, leading to increased vessel permeability, subsequent disruption of the outer BRB was suspected to result in a neurosensory retinal detachment. We hypothesize that a recovery of RPE function and subsequent resolution of subretinal fluid collection was made possible presumably by partial restoration of the blood circulation by tributaries of the supero-temporal vortex vein draining the occluded part of the choroid. Experimental studies have shown M. Kim : H. J. Kwon : S. C. Lee (*) Institute of Vision Research, Department of Ophthalmology, Severance Eye and ENT hospital, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea e-mail: sunglee@yuhs.ac Graefes Arch Clin Exp Ophthalmol (2013) 251:1005–1006 DOI 10.1007/s00417-012-1976-x